Clinical Guidelines for Management of Gastrointestinal Symptoms in Cancer Patients: The Japanese Society of Palliative Medicine Recommendations.

Background: Gastrointestinal symptoms, including nausea, vomiting, bowel obstruction, ascites, constipation, and anorexia, are common and often refractory in advanced cancer patients. The palliation of gastrointestinal symptoms is important in improving the quality of life of cancer patients, as well as that of their families and caregivers. Currently published clinical guidelines for the management of gastrointestinal symptoms in cancer patients do not comprehensively cover the topics or are not based on a formal process for the development of clinical guidelines. Methods: The Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of gastrointestinal symptoms in cancer patients after a formal guideline development process. Results: This article summarizes the recommendations along with their rationale and a short summary of the development process of the JSPM gastrointestinal symptom management guidelines. We established 31 recommendations, all of which are based on the best available evidence and agreement of expert taskforce members. Discussion: Future clinical studies and continuous guideline updates are required to improve gastrointestinal symptom management in cancer patients.

[Successful treatment of an elderly patient with advanced gastric cancer using low-doses of 5-fluorouracil, levofolinate calcium, and cis-platinum with chronomodulation].

An 83-year-old man was admitted to our hospital for abdominal pain and severe vomiting. Gastrography and gastric endoscopy revealed that the pylorus was obstructed by a giant type 2 cancer in the lower gastric body. Furthermore, computed tomography revealed multiple metastases in the para-aortic lymph nodes. The man was unable to consume any food or liquid, and could not take medicine orally. Paclitaxel was not effective in treating the lymph node metastases or vomiting; therefore a chronomodulated schedule was used, which involved the administration of low doses of 5-fluorouracil, levofolinate calcium and cis-platinum (FLP) each night. After four cycles of low-dose FLP therapy, the patient was able to consume food orally. The patient has partially responded to this regime over five months. In the current study, low-dose FLP therapy with chronomodulation was considered an effective treatment, and there were no severe adverse side effects. This case suggested that low-dose FLP therapy with chronomodulation is promising for the treatment of gastric cancer in elderly patients who can not take medicine orally, and further trials are warranted.

Squamous cell carcinoma-antigen messenger RNA level in peripheral blood predicts recurrence after resection in patients with esophageal squamous cell carcinoma.

BACKGROUND: The aim of this study was to clarify whether preoperative squamous cell carcinoma-antigen messenger RNA (SCC-Ag mRNA) level in peripheral blood can be used to predict tumor recurrence after curative resection for esophageal squamous cell carcinoma. METHODS: A prospective analysis was conducted for 46 consecutive patients who underwent curative esophagectomy and who had no residual tumor. The SCC-Ag mRNA level in the peripheral blood of each patient was measured preoperatively by using quantitative reverse transcriptase-polymerase chain reaction. Median follow-up period was 34 months. RESULTS: Receiver operating characteristic analysis demonstrated that the optimal cutoff level of SCC-Ag mRNA was 40. Patients were divided into the high SCC-Ag mRNA level group (n = 14) and the low SCC-Ag mRNA level group (n = 32). The cumulative probabilities of tumor recurrence were higher in the high SCC-Ag mRNA level group (probability of recurrence was 71% at 2 years) than in the low group (22% at 2 years; P = .0005). SCC-Ag mRNA level (relative risk, 3.00; 95% confidence interval, 1.05-8.54; P = .040) was the strongest independent predictor of recurrence by multivariate analysis. CONCLUSIONS: Preoperative SCC-Ag mRNA levels in the peripheral blood are the best predictive factor for recurrence in patients with esophageal squamous cell carcinoma who undergo curative resection (R0).

[Successful treatment of an elderly patient with pretreated recurrent breast cancer using low-dose capecitabine].

The author reports the successful treatment of an 85-year-old recurrent breast cancer patient with low-dose capecitabine. Approximately 20 years ago, the patient received a left mastectomy and 2 years later was treated with unspecified chemotherapy for bone metastasis. In November 2001, metastatic tumors in thoracic vertebrae were removed by emergency laminectomy, followed by radiotherapy plus chemotherapy using mitoxantrone, cyclophosphamide and doxifluridine. In June 2005, abdominal computed tomography revealed a single metastatic tumor 20 mm in diameter in the liver. Treatment with paclitaxel at 70 mg/m(2)/day on days 1 and 14 resulted in no change in tumor size while serum levels of cancer antigen 15-3 increased from 22.1 to 98.1 U/ml. Subsequent daily treatment with capecitabine at 1,000 mg/m(2)/day for 21 days was associated with a 50% decrease in tumor size and a reduction in serum cancer antigen of 15-3 to 18.8 U/ml. Grade 2 hand-foot syndrome was noted,but no severe adverse effects were evident. Five months after the induction of capecitabine treatment, a partial response was obtained. These results suggest that low-dose capecitabine may be a safe and efficacious treatment for elderly patients with pretreated recurrent breast cancer. Clinical trials of low-dose capecitabine in such patients are therefore warranted.